WITH this issue, the e-news continues its coverage of the momentum building among Mayors and County officials who are Charter Signatories to the unprecedented 12-point America's Road Home Statement of Principles and Actions to end chronic homelessness, bringing the signers to a total of more than 75.

"The Mayor of the nation's largest city, who has shown commitment, partnership, and innovation in planning, policy, and investment to end homelessness, has now joined America's Road Home as a Charter Signatory, joining a growing number of elected officials from across the country," indicated United States Interagency Council on Homelessness Executive Director Philip Mangano. Mayor Bloomberg co-convened the Mayors Against Illegal Guns initiative, which served as a model for the Summit co-convened by the Interagency Council in Denver last November and which resulted in the America's Road Home Statement.

Director Mangano noted that New York City recently hosted its third annual Project Homeless Connect event citywide, and that the implementation of Mayor Bloomberg's plan, Uniting for Solutions Beyond Shelter, under the leadership of Deputy Mayor Linda Gibbs and Commissioner Robert Hess, has included adoption of other key innovations to end street homelessness, address homelessness among veterans, increase prevention, and support appropriate discharge planning. New York City reported a 7% reduction in chronic homelessness from 2005 to 2006.

Ashland, KY Mayor Stephen Gilmore, who recently hosted Director Mangano for the unveiling of Ashland's 10-Year Plan focused on housing, education and employment, medical services, and policy, became a Signatory.

Bridgeport, CT Mayor Bill Finch, a newly inaugurated Mayor whose record of service includes serving as State Senator, Bridgeport City Council member, and elected Town Constable at age 19, and Burlington, VT Mayor Robert Kiss, a former State Representative, became the latest New England Mayors to sign the Statement.

Durham, NC Mayor Bill Bell, whose "10- Year Results Plan" developed with Triangle United Way is in implementation and whose city hosted a Project Homeless Connect event in October, signed the Statement.

Yakima, WA Mayor Dave Edler, a former Seattle Mariners professional baseball player and pastor of Yakima Foursquare Church, became a Signatory.

Lane County, OR Commissioner Faye Stewart, from a rural area of Oregon that includes Eugene, became a Signatory, confirming the partnership shown in ending homelessness with Eugene Mayor Kitty Piercy.

Fresno, CA Council Member Brian Calhoun, whose city gave final approval to its 10-Year Plan timeline this week (see related story), signed the Statement.

At the November Denver press conference announcing the signing of the Statement, participating Mayors declared their intent to promote America's Road Home with their fellow Mayors and County officials. The Statement has been made available to other Mayors and County officials to sign. Mayors and County officials who are interested in becoming partners to the agreement can download the Principles and guidelines for signing at the Council's web site at www.usich.gov. A current list of the Charter Signatories is also posted.

The Summit was convened by Denver Mayor John Hickenlooper, United States Interagency Council on Homelessness Executive Director Philip Mangano, and Melville Charitable Trust President Robert Hohler. The Summit was supported by Fannie Mae.

MOBILE, ALABAMA. Mayor Sam Jones convened public and private partners from across the city, county, and neighboring communities this week to evaluate progress on the goals of Mobile's 2005 Plan to End Chronic Homelessness and to encourage regional planning and coordination in the goal to end homelessness. Mobile undertook its recalibration initiative to assess progress based on the 2005 release of its plan and ongoing community response to Katrina in the region.

United States Interagency Council on Homelessness Executive Director Philip Mangano, who joined Mayor Jones and his executive staff, Dan Williams, Executive Director, Housing First, Inc., Homeless Coalition of the Gulf Coast, and Barbara Drummond, Executive Director of Administrative Services and Community Affairs Division, affirmed the intent of the partners as they recalibrated their plan and commended them on following this emerging best practice for communities in implementation.

Director Mangano encouraged the partners to conduct cost benefit research in their community, adopt a Project Homeless Connect strategy, and incorporate regional strategies, noting Mayor Jones' outreach to surrounding jurisdictions and the participation of Fairhope, Alabama Mayor Tim Kant and Fort Walton Beach Councilmember Bill Garvie. He emphasized the importance of business partners to the future success of the plan and needed investment in solutions.

The strategy meeting was followed by a media event, where John Gemmill, of HUD's Birmingham office, presented officials from the city and county with a check representing their recent and record McKinney- Vento award for Mobile and Baldwin County. The partners are pictured here at the presentation: Fairhope Mayor Tim Kant, Staff of Congressman Jo Bonner, Fort Walton Beach, FL Councilman Bill Garvie, Staff of Senator Richard Shelby, AL, HUD Birmingham Field Office's John Gemmill, Director Mangano, Housing First President Larry Moons, Mayor Jones, and Task Force to End Chronic Homelessness Chair Jamie Praytor.

To encourage further partnership and commitment from all stakeholders, Director Mangano met with elected officials and community leaders from Mobile and Baldwin Counties at Saenger Theatre, hosted by Al Stokes, Chief of Staff for Mayor Jones. Rev. Charles Fail, St. Francis Street United Methodist Church, provided the invocation for the partners' efforts. Partners included the Mobile City Council, Mobile County Commission, Baldwin County Commission, Mobile Police Chief, Mobile County Sheriff, Baldwin County Sheriff, Task Force Chair, United Way, Bedsole Foundation, Sybil Smith Charitable Trust, Community Foundation, Chamber of Commerce, and Mobile Area Interfaith Conference Chair.

The Mobile visit concluded with Director Mangano's presentation at Government Street Presbyterian Church Fellowship Hall, where he met with the Mobile- Baldwin Homeless Task Force (pictured here) and representatives from agencies and churches that serve homeless citizens in the two-county region. Jamie Praytor, Chair, Mobile-Baldwin Homeless Task Force, presided.

SEATTLE, WASHINGTON. Seattle Mayor Greg Nickels this week released data showing that the city saved $3.2 million in emergency shelter and health care costs by placing 160 chronically homeless individuals into permanent supportive housing.

"To end homelessness, we must find programs that work in reaching those who are the hardest to reach," Mayor Nickels said. "These studies show that Housing First works. Instead of letting people fall through the cracks, this program helps to stabilize and rebuild lives while taking a costly strain off our social safety net."

Separate studies by University of Washington researchers of Seattle's first two Housing First projects - 1811 Eastlake and Plymouth on Stewart - revealed similar findings. Preliminary research shows an estimated savings of $3.2 million because of fewer visits by these formerly chronically homeless individuals to the Harborview Medical Center and the Dutch Schisler Sobering Center, as well as less use of other crisis-treatment services. Every year, the city spends approximately $40 million to prevent or end homelessness. Since 2006, Seattle has added more than $6 million in general fund resources for Housing First housing and service programs.

The Housing First programs are operated by the Downtown Emergency Service Center (DESC) and the Plymouth Housing Group (PHG) and supported by the City of Seattle. In the past two years, they have helped to change the lives of 100 chronically homeless individuals.

"This is a tremendous start. Working with our partners at King County, the United Way and others, we will see more facilities like these open in the months and years ahead," said Mayor Nickels. "With every new building, we take a big step toward ending homelessness in our community."

For the residents of Plymouth on Stewart, medical costs were dramatically reduced by 75 percent - or $1.2 million - from the year prior to housing placement. Sobering Center visits dropped 97%, from 349 to just 11. Medical respite days dropped from 1,107 to zero, and inpatient hospital days dropped from 329 to 56, or 83%. Emergency room visits decreased from 191 to 50, or a 74% decrease. Residents reported that the program helped them deal more effectively with daily problems, improved their physical health, and helped them reduce drug use.

Since the opening of 1811 and Plymouth on Stewart, two more projects have been completed with the help of city funding. DESC's Evans House opened in fall 2007 and houses 75 severely mentally ill people. PHG's Langdon and Anne Simons Senior Apartments opens this month and features 23 units reserved for homeless seniors who frequently use emergency services and 22 units for homeless veterans.

In total, the city has helped pay for 215 Housing First units in Seattle. Another 288 are under construction or planned to open by 2011. A total of 1,000 are planned countywide under the Ten-Year Plan to End Homelessness.

INDIANAPOLIS. In the closing days of December, the Indianapolis and Marion County Council voted to add an estimated $1.6 million to housing funds for the state and county through an increase in the real estate transaction recording fee. The Council voted in favor of the increase, which represents the first dedicated revenue stream for the City's housing trust fund which will receive 60 percent of projected revenues, with the balance going to the State's housing trust. The higher fee is expected to direct about $1 million per year toward the City's efforts to reduce homelessness and build more housing that is affordable for those in need.

D. William Moreau, Jr., Board Chairman of Indianapolis' Coalition for Homelessness Intervention and Prevention (CHIP), said the new fee would add $21.50 to the average mortgage document of 20 pages. The fund assists housing projects in a variety of ways ranging from rental assistance to supporting goals of the city's Blueprint to End Homelessness, the first jurisdictional plan in the nation, created under former Indianapolis Mayor Bart Peterson.

Some earlier contributions to the fund were one-time additions, such as a $1 million contribution from a development group. Last June, the fund received its first permanent funding from a fee on electronic filing of property sales disclosure forms, bringing in about $300,000 per year.

THIS WEEK, Indiana's Lilly Endowment announced a $2.9 million grant to the United Way of Central Indiana for five homeless initiatives, including the Indianapolis Blueprint to End Homelessness, according to UWCI's President and CEO Ellen K. Annala.

"Simply put, there would be no CHIP, no 'Blueprint to End Homelessness' and no commitment to the cause of ending homelessness in our community without the steadfast support of Lilly Endowment and United Way," said Mr. Moreau. "We at CHIP look forward to working closely with our United Way partners to ensure that the results sought by the Endowment are achieved and to demonstrate that our community knows what works to end homelessness."

The Lilly Endowment funds will be used to:
- Develop sustainable, permanent support services for residents of 150 housing units. More than half of the Endowment grant - $1.6 million - will be used to reduce overall operating costs for the units, which will help generate an estimated $254,000 annually to pay for supportive services for residents.
- Conduct a feasibility study for an Engagement Center to serve an estimated 500 chronically homeless people and offer an alternative for people who are now incarcerated without treatment.
- Provide technical assistance to both new and existing service providers so they can use the most current and proven programs that focus on housing homeless people.
- Conduct a community awareness campaign in 2008 to encourage people to redirect "impulse giving" from panhandlers to service providers who use comprehensive approaches to ending homelessness.
- Move more families quickly to permanent housing and out of shelters, while providing short- term support services. Each year, 25 families will receive help tailored to their individual needs to maintain housing, using a coordinated case management system.
- Measure and evaluate the initiatives to assess their impact and track the housing inventory.

BOSTON, MASSACHUSETTS. "Cities often battle homelessness in crisis mode, relying heavily on shelters. It is time to change, to slowly shift resources away from shelters and into permanent housing and services to help people rebuild their lives." With these words, The Boston Globe editorialized on the latest results from across the state - including a reported 40% decrease in street homelessness in Boston - in which prevention and intervention strategies are showing results.

Among the investments showing results is the state's Home and Healthy for Good Housing First initiative. The Commonwealth of Massachusetts' FY 2008 budget doubled the investment in the Home and Healthy for Good program to $1.2 million. The Massachusetts Housing and Shelter Alliance, lead agency for the Housing First initiative, has just issued a new report on the pilot year of the statewide initiative which housed 227 people as of November 2007, with a housing retention rate of 86%.

According to MHSA data, the average length of homelessness upon entry into the HHG program was 5 years. The costs per person per month, including the cost of housing and services, decreased from $2,720 before housing to $1,939 after housing placement, or $32,640 and $23,268 annualized, with a projected annual cost savings to the Commonwealth of $9,379 per person housed, or $2.1 million.

Out of a total of 30 veterans who are HHG participants, 27 have remained housed in the program, resulting in a residential stability rate of 90%. Cost savings for the veterans population were higher than for placements as a whole, resulting in $13,358 savings annually per person.

In the six months prior to entering housing, 184 participants accounted for 385 emergency room visits, 853 days in inpatient care, and 17,177 nights in emergency shelter. The use of these services decreased substantially following participation in HHG. MHSA has made conservative estimates of the costs associated with these and other services, using data on emergency room, hospitalization, ambulance, respite, detox, and incarceration costs in the state, with data from Blue Cross Blue Shield, Massachusetts Division of Health Care Finance and Policy, Boston Health Care for the Homeless Program, and the Massachusetts Departments of Public Health and Transitional Assistance.

United States Interagency Council Executive Director Philip Mangano hailed the new results, indicating: "Leadership at every level of government and in the private sector in Massachusetts - from Senate Ways and Means Chair Therese Murray to State Commission on Ending Homelessness creator Representative Byron Rushing - is continuing the working of abolishing homelessness in the Commonwealth." Director Mangano noted the work of MHSA Director Joe Finn and Dr. Jessie Gaetano: "Their cost-oriented research is bringing the antidote of housing to people who are homeless and the remedy of results to public policy on homelessness."

The Massachusetts Legislature passed new line-item 4406-3010 for persons who are chronically homeless as part of the FY 2007 state budget. Funds were to be used for a portion of the service or housing components for program participants, with the expectation that federal or other state resources will be leveraged to finance additional needed service or facilities funds. The Legislature requested that an evaluation of this pilot program be performed, with a focus on the cost per participant and projected cost- savings in state-funded programs. The legislatively created commission developing a five-year plan to end homelessness in the state will release its report today.

Noted The Boston Globe: "Now the state should move past experiments and commit to long-term action. Progress is pending . . . Rather than spending so heavily on a crisis that is decades old, Massachusetts should invest in housing solutions that help people, and communities, thrive. "

LOS ANGELES. The new strategic partnership between Los Angeles City and County officials that is moving to identify and prioritize housing and services for the most vulnerable and disabled on the streets received a boost this week as the Los Angeles County Board of Supervisors unanimously approved new features for the three-year, $5.6-million pilot program called "Project 50," designed to provide immediate housing and services for vulnerable and disabled persons living on Skid Row.

Project 50 organizers will now report to the Supervisors at least quarterly on their results, and the County has called for the creation of an executive steering and oversight committee of county officials and others. A public health nurse is expected to direct the initiatives, with teams of county social service workers to help house people, provide them with medical and other care, and assist them in applying for benefits.

Next week a 7-member county social services team - a social worker, mental health employees, advocates, a representative of the Veterans Administration and a benefits specialist - will return to Skid Row to look for the 50 people identified in December through intensive risk assessment and identification and encourage them to move to county-funded apartments and get regular medical and mental-health care. Skid Row Housing Trust will provide 50 downtown living units to the initiative along with two case managers, a medical exam room, offices, and a support-group meeting space.

From 4 am to 7 am for two weeks in December, more than two dozen volunteers from county agencies and social service groups, working with the Street to Home team from Common Ground Community, surveyed a 40-block area, noting the location of sleepers, centers of drug activity, and the individual "anchors" in various areas that are a key to the strategy.

The workers also categorized 50 people as most at risk if they had been homeless for at least six months with at least one chronic ailment, or recent emergency room visits or hospitalizations. Those identified had visited emergency rooms 120 times in the previous three months and had lived on the streets an average of 9 1/2 years, according to the survey results. The surveyors counted 471 people routinely sleeping in the area and persuaded 350 of them to be interviewed, offering free phone or fast-food gift cards.

The initiative includes an evaluation component that will compare the costs and outcomes for the 50 anchors to a cohort group of 50 chronic homeless of similar vulnerability who remain on the streets. The budget also includes projected medication costs based on assumptions that there may be a higher acuity of illness among the 50 anchors, and a greater proportion may need newer, more expensive antipsychotic and antidepressant medications, and multiple medications initially.

As noted in the e-news previously, Los Angeles City and County officials led by Board of Supervisor Zev Yaroslavsky and Mayor Antonio Villaraigosa have sought a more effective approach to homelessness in Skid Row" In October 2007 a meeting convened by then Supervisor Chair Yaroslavsky, the City of Los Angeles, the United States Interagency Council on Homelessness, Common Ground, and the Rockefeller Foundation brought together innovators from around the country with Los Angeles city and county leaders to discuss innovative approaches that are achieving results in reducing and ending street homelessness. With support from new County Supervisors Chair Yvonne Burke, a longtime supporter of solutions for homeless people, city and county leaders agreed to move forward with Project 50.

FRESNO, CALIFORNIA. In Fresno, where Federal, State, County, and City partners convened in December to launch a 10-Year Plan, final approval was given this week by the Fresno City Council and the County Board of Supervisors to form a joint task force to develop the Plan over the next 100 days.

United States Interagency Council on Homelessness Executive Director Philip Mangano joined the government, private sector, and community partners for the city-county commitment and launch of the plan in December (pictured here). At that event, Congressman Jim Costa, who represents the area, welcomed jurisdictional partners to the joint session of the Fresno City Council and Fresno County Board of Supervisors.

Fresno Mayor Alan Autry, who hosted Director Mangano, championed the effort and affirmed his commitment to the planning process. Mayor Autry took the opportunity to become a Charter Signatory to the America's Road Home Principles on that day. Representative Costa had sought the partnership of the United States Interagency Council on Homelessness in 2006 to foster the jurisdictional commitment to a plan. While in joint session in December, elected jurisdictional representatives unanimously voted to adopt two identical motions that commit the City and County to develop a 10-Year Plan to End Chronic Homelessness over the next several months.

The newly approved joint planning task force - expected to have 15 to 19 members - will be appointed by a committee from the City and County and is expected to hold the first of its six planned meetings early next month.

WASHINGTON, DC. President Bush swore into office his new Secretary of the United States Department of Veterans Affairs, Lt. Gen. James B. Peake (Ret.), M.D., on December 20 at the Department of Veterans Affairs headquarters. Secretary Peake is the first physician and first General to lead the Department. Joining the President for the ceremony were Vice President Richard Cheney, Department of Defense Secretary Robert Gates, and Department of Labor Secretary Elaine Chao, as well as former VA Secretary and United States Interagency Council on Homelessness Chair Jim Nicholson.

"His decades of expertise in combat medicine and health care management have provided him with a thorough understanding of the department's responsibility to care for America's veterans," President Bush said in a statement about Secretary Peake.

Added the President: "One of his first tasks as Secretary will be to ensure that my Administration continues to swiftly implement the recommendations of the Dole-Shalala Commission on Wounded Warriors. I am confident that he will build upon our record of improving care, reducing bureaucracy, and ensuring that our veterans receive the benefits they deserve."

The new Secretary, who retired in 2004 as a three-star general, is a board-certified thoracic surgeon. As the 40th Surgeon General of the United States Army, he commanded 50,000 medical personnel and 187 army medical facilities worldwide with an operating budget of almost $5 billion. As Surgeon General, he was credited with improving the training and techniques of the Army medical force. He served as Commanding General of the U.S. Army Medical Department Center and School - the largest medical training facility in the world, with over 30,000 students.

A native of St. Louis and graduate of the U.S. Military Academy at West Point, the Secretary attended medical school after serving in Vietnam, where he earned the Silver Star and Purple Heart. He was wounded twice in battle and received his acceptance letter to Cornell University Medical College while in the hospital recovering from injury. He attended medical school through an Army scholarship and then returned to the Army for his medical internships and residencies.

After retiring as Surgeon General, the Secretary was the Executive Vice President and Chief Operating Officer of Project HOPE, a non-profit international health foundation with offices and programs in more than 30 different countries on five continents. Most recently, he served as the Chief Medical Director and Chief Operating Officer of QTC Management, Inc. QTC serves veterans and separating soldiers by providing timely medical examination and electronic medical record services to help government agencies manage medical data and information in a cost-effective manner.

Secretary Peake has been honored with the Distinguished Service Medal, Defense Superior Service Medal, the Legion of Merit with three oak leaf clusters, the Meritorious Service Medal with two oak leaf clusters, and an Air Medal. He wears the Combat Infantryman Badge.

WASHINGTON, DC. Research and practice for persons with co-occurring mental illness and addictions are the focus of three new reports issued by the United States Department of Health and Human Services' Substance Abuse and Mental Health Resources Administration. The papers cover Services Integration, Systems Integration, and Epidemiology.

The reports provide information about how epidemiology, services integration and systems integration research and practices can be best utilized in helping people with co-occurring substance use and mental disorders. The publications are the final in a series developed by SAMHSA's Co-Occurring Center for Excellence (COCE), and are based on the best available science, research and practices primarily geared for a wide array of mental health and substance abuse treatment service professionals.

Services Integration defines and explains how services integration practices can help merge previously separate substance abuse treatment and mental health clinical services provided at the individual level to people with co-occurring disorders. Combining and coordinating these treatments at the level of direct contact with individual clients can better ensure that their full range of treatment needs are addressed. This approach emphasizes that successful treatment of co-occurring disorders is very often based on providing all the client's treatment needs as concurrently as possible.

Systems Integration outlines the benefits of developing public health infrastructures that systematically integrate mental health and substance abuse treatment programs to better meet the full needs of people with these disorders. The paper encourages integrated system planning, continuous quality improvement analysis activities and other practices that lead to more effective, comprehensive public health services for meeting the health needs of this client community.

The Epidemiology of Co-Occurring Substance Use and Mental Disorders is presented in two parts. Part 1 provides the general public with a basic understanding of the field of epidemiology and how it has been used to shed light on the problem of co- occurring disorders. In particular, it focuses on three major studies that are regularly referenced as prime sources of information on the nature and scope of this problem. Part 2 is geared more to the scientific community and provides more detailed technical information on these three studies.

ALSO IN WASHINGTON, HHS' Administration for Children and Families (ACF), Family and Youth Services Bureau has announced the availability of $12.5 million in resources for an estimated more than 90 awards of up to $200,000 for the Basic Center Program to address needs of runaway and homeless youth (RHY). BCPs provide an alternative for runaway and homeless youth who might otherwise end up in law enforcement , child welfare, mental health, or juvenile justice systems. Each BCP must provide runaway and homeless youth with a safe and appropriate shelter, individual, family, and group counseling as appropriate, and aftercare.

Applications are due February 19, and interested applicants should read the full announcement. Eligible applicants for the resources include State, County, and City governments, Public and Indian Housing Authorities, and non-profits.

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